Voice amplification options

My dad is 71 y/o and has been living with PD for over 10 years. The last 3 years his voice has become very, very hard to hear. He does not slur his words but his voice is so faint that it is really hard to hear him. We are constantly asking him to repeat what he said or speak up. He's able to speak up when he tries by taking a deep breath before he speaks (a trick he learned in past SLT sessions) but he doesn't do this very often. I have seen on this forum that there are different voice amplification gadgets out there but the post was from 2009 and I was wondering if anything more advanced and with better results has surfaced during the past 2 years. He doesn't want to go back to speech therapy although I think my mom will insist but in the meantime, what tools are available to help with his voice amplification?

Changes in speech are very common in PD with approximately 75-90% of people experiencing some type of change in speech features. Reduced loudness is a key feature that is caused by changes in the muscles of speech production AND changes in the person's ability to accurately monitor their own loudness levels.

Speech amplification devices are available at different price ranges. If you enter voice amplification devices on a web browser several options will appear. The problem with voice amplification devices is that they only address a portion of the communication problem. Your Dad needs to be doing speech exercises to maintain the function of speech muscles. This is important not only for speech but for swallowing as well. I have not seen your Dad so cannot make a specific recommendation about his individual situation. However, in general, when people are that hard to understand, safe swallow function may also be compromised. This can potentially lead to serious health consequences. Therefore, I recommend your Dad goes back to a speech-language pathologist at least for an evaluation. He can decide whether he wants to participate in treatment or not but you would at least learn what the recommendations are and whether there are any swallowing problems. The literature about the benefits of exercise for PD is compelling and this includes speech exercises.

In the meantime, choose an amplification device that fits your budget and/or remind your father that if he doesn't feel like he is shouting, then he is not speaking at normal loudness. It takes extra effort for the person with PD to speak at normal loudness.

Changes in speech are very common in PD with approximately 75-90% of people experiencing some type of change in speech features. Reduced loudness is a key feature that is caused by changes in the muscles of speech production AND changes in the person's ability to accurately monitor their own loudness levels.

Speech amplification devices are available at different price ranges. If you enter voice amplification devices on a web browser several options will appear. The problem with voice amplification devices is that they only address a portion of the communication problem. Your Dad needs to be doing speech exercises to maintain the function of speech muscles. This is important not only for speech but for swallowing as well. I have not seen your Dad so cannot make a specific recommendation about his individual situation. However, in general, when people are that hard to understand, safe swallow function may also be compromised. This can potentially lead to serious health consequences. Therefore, I recommend your Dad goes back to a speech-language pathologist at least for an evaluation. He can decide whether he wants to participate in treatment or not but you would at least learn what the recommendations are and whether there are any swallowing problems. The literature about the benefits of exercise for PD is compelling and this includes speech exercises.

In the meantime, choose an amplification device that fits your budget and/or remind your father that if he doesn't feel like he is shouting, then he is not speaking at normal loudness. It takes extra effort for the person with PD to speak at normal loudness.

Thank you for writing with this important question.

Dr. Mahler, PhD, CCC-SLP

Thank you for your suggestions. He had been going to speech therapy but quit after a while and stopped practicing his exercises. My mom eventually insisted that he go back and he just started going back this week. Hopefully, that can make a difference.

I’m glad your dad decided to return to speech therapy. Regular speech exercise is important for persons with PD and is supported by evidence based practice. That said, I have worked with some families, who for various reasons, choose to purchase such a device with the hopes of improving communication. Voice amplification devices simply make the speaker’s voice louder. If a person with PD is slurring or mumbling their words, talking at a fast rate, experiencing dysfluencies or ‘stuttering-like’ behaviors, voice amplification will not be of much help.

Voice amplification devices have typically been used for school teachers to reduce their need to talk loud in the classroom. There are studies that have documented that these devices help to prevent voice disorders in teachers and are beneficial to students, as they can hear the teacher better. These devices are also used by tour guides, aerobic instructors, and others who simplify want to make their voice louder. There are no studies that have investigated the effectiveness of voice amplification devices for persons with Parkinson disease (PD). However, I have worked with some families who have purchased such devices. Some have found them helpful, while others have not. So here are some things to think about regarding the purchase of a voice amplification system for your dad.

If your father can speak rather clearly, not too fast and his main problem in being understood is that he uses a soft voice, an amplification device might help to improve communication. If you decide to pursue the purchase of a voice amplification device, there are many out there. Some are very inexpensive while some are pricey. Here are some suggestions I’ve discovered in counseling families with their purchase. An inexpensive device will not meet your needs, because it does not sufficiently amplify the voice. The more expensive devices provide the needed level of amplification and can be adjust to meet the needs in various communication settings (e.g. one-on-one versus group). Here are some specific recommendations for choosing a voice amplifier:

1) Find a wireless device that amplifies 15 watts or at least 15- 20 dB. Devices that amplify at lower levels are not effective in your situation. Devices that are worn on a person’s waist are ineffective because they are small and cannot provide the a sufficient amount of amplification. Although wireless devices are larger, they provide greater amplification and flexibility in volume control. They are placed on a table in a room and don’t have to be worn around the speaker’s waist. The volume can be adjusted to the situation. In a group setting the volume can be turned up. For smaller one-on-one conversations the volume can be turned down. The speaker only wears a microphone.
2) It’s best to purchase a microphone that is either attached by a clip on the speaker’s shirt (lapel mike) or a head held mike that is strapped about the person’s head. A mike that has to be hand held is cumbersome. You want hands free!

To get started on your search, look into the BoomVox Wireless Amplifier (Griffin Labs). Then search other voice amplification for comparison. Finally if you decide to purchase an amplification device, make sure that either you can test it out before purchase or have an option to return it within a certain timeframe if you find that it is not helpful.

I hope I’ve answered your questions and have provided guidance that will help you to make a decision about how to communicate more effectively with your Dad! There are many choices for treating communication problems associated with PD. Some have evidence-based data that attest to the effectiveness in treating speech problems, while some have anecdotal evidence. It is ultimately up to you to decide what feels right!